Fetuin-A is an ubiquitary anti-inflammatory protein that counteracts CRP effects and has a protective effect against inflammation and myocardial ischemia. Low fetuin-A has been found to be associated with cardiovascular death in patients with end-stage renal failure disease. Low fetuin-A combined with high CRP level may be used to severe inflammatory imbalance and to predict outcome in acute coronary syndromes (ACS).

We measured admission plasma fetuin-A and CRP level in 748 consecutive patients (65±13 years, sex, 389 with ST and 337 without ST elevation) included in the ACS French registry (Fast MI) and correlated these data with the outcome. Tertile was used to define low fetuin-A (tertile 1) and high CRP level (tertile 3). Results: Plasma fetuin-A and CRP concentrations at admission averaged 95±27mg/L and 11±16UI, respectively with low fetuin-A defined as <69mg/L and high CRP level as 25UI. At one year follow up (n=726, 97%), cardiovascular mortality (n=50, 7%) was 16% (18/111), 9% (21/250) and 3% (11/365) in patients with low fetuin-A/high CRP (n=111), either low fetuin or high CRP (n=250) and high fetuin-A/low CRP (n=365), respectively. By multivaritate analysis low fetuin-A/high CRP level remained independently predictive of outcome (OR=3.4 [1.6–7.3], p=0.001, Figure 1) after adjustment to ST elevation, GRACE score and medical treatment. In contrast, CRP and fetuin-A alone failed to predict outcome.

Inflammatory imbalance assessed by combining fetuin-A and CRP values is an important predictor of cardiovascular death in ACS patients.